REQUIRED! Confidential Client
Information. Please complete both
pages/sides of this form. If you need more
space, you may attach an additional page.  

REQUIRED! Policies and Information. Print 2-copies, READ THOROUGHLY,--you will be tested on your knowledge of the content, ;o) --sign and date both copies and return one copy to me, Dr. Ruth.

If you have any questions or concerns before signing this form, please feel free to discuss them with me.

Insurance Verification. This brief form has to be completed if you want to find out if your insurance policy might cover part of your counseling cost.

Financial Arrangements. You will need this form if you will only be paying a portion of your session fee at a time. Print two copies. We will fill out the forms together.

Authorization for Exchange of Information. This form is required if you would like a copy of all or part of your life coaching/holistic counseling file shared with another professional.

Strongly Requested!
Personal Stumbling Blocks. This list can help you to identify any negative feelings and behaviors that may be keeping you blocked or stuck in old unwanted responses.

Strongly Requested!
Are you Ready for Personal Growth and Prosperity Coaching/Holistic Counseling? This self-assessment quiz will help to determine how ready you are for my services.

Strongly Requested!
Turning "Stumbling Blocks" Into Personal Growth by "Building Blocks" for Personal Growth. This work sheet will help to isolate old beliefs that stop you from reaching your full potential.  

Strongly Requested!
Holistic Counseling Index. By going over this check list, you can choose the items that you would like to address during our work together.

Depressed? Depression Work Sheet. Click on Are You Feeling Depressed? to read this article.

Anxious? Anxiety Work Sheet. For more information go to my articles on, What is an Anxiety Disorder? and What Causes Anxiety?

Panicky? Panic Attacks (and Agoraphobia)
Work Sheet. Go to my article on What is an Anxiety Disorder for more information on Panic Disorders

Phobic, Scared or Fearful? Assessing Your Fears List. More about phobias are discussed in my article, What is an Anxiety Disorder?

Turning "Stumbling Blocks" Into Wealth by "Building Blocks" for Wealth! Have you ever wondered why you have not been financially successful, or perhaps, you can make money but you cannot seem to keep it?

S.M.A.R.T. Goals. This simple guide will help you to understand how to set achievable goals.

Emotional Assessment. This paper gives a list of words that describe positive and negative emotions. It can help you find ways to express your feelings more accurately.

Are You Highly Sensitive? Take this quiz. You might need to learn how to thrive in an overwhelming world....

Wheel of Life Exercise. This chart gives you a place to visually track major areas in your life, and to determine where more balance is needed.

Wheel of Life Exercise, blank. On this chart, you can fill in and track the areas you choose.

The First Step. What are the energy drainers in your life? List them on this work sheet and get them resolved in session.

What to Talk About With Your Personal Growth & Prosperity Coach / Holistic Counselor During Your Session. Here is a guide for staying on track with the issues in your life and getting them settled.

Writing Your Life Story is Really Very Easy. Our lives follow many tracks at the same time. For instance, we can do a time line on our relationships, our jobs, and our hobbies as they evolve over the years.

This short instruction sheet gives you directions on how to organize your thoughts and experiences into an autobiography of your life.

Your Life Story. This form provides you with a starting point for creating your life story. Before starting, read the above instruction sheet, "Writing Your Life Story is Really Very Easy."

Watch the "Amazing Universal Healing Aid." This is a 7-minute video by Gary Craig, EFT Founder, and produced by the Director of "The Secret."

EFT Basic Shortcuts. You will usually start with this version of EFT because it is so simple to learn, and quickly provides impressive results.

EFT Basic Instructions. This version is for the client who is seeking a more effective way to work with EFT.

Raising Your Metabolism (or Immune System) with EFT. This is a simple treatment plan that targets a specific concern.

EFT Drama Words. To take your EFT experience to the next level, consider empowering your set-up statements with "Drama Words."

Can Bach Flower Remedies Help You
Emotionally? There are 116 questions
in this questionnaire that is designed to
help you identify areas of distress in your
life.

Many people are acquainted with the well
known Bach Flower Rescue Remedy. There are a total of 39 more remedies available for treating specific concerns. These pure liquid tasteless remedies are made from flower essences, are completely safe, and support the individual by correcting emotional upsets, and stimulate the potential for self-healing.

After you have completed, "Can Flower Remedies Help You Emotionally?" I will review the answers with you.

If we are doing sessions in person, I can then muscle test you for selecting the appropriate remedies for the conditions you have indicated. Alternately, I can teach you some muscle tests you can do on yourself.

Note: I do not sell or provide these products; however, with the information we gather, you can then make suitable purchases from the health food or vitamin store of your choice.

How to Use Bach Flower Remedies. This is an extremely handy 6-page instruction manual. It tells you the many different ways you can use the flower essences. For example, it describes how to use them and what to expect. In addition to yourself, you can use them on plants, pets, animals, children, adults, and seniors.

Abuse Checklist: Women. Are you confused about whether you are really experiencing physical or emotional abuse? This checklist can help you to evaluate your experiences.

Stop Smoking For Good: Program Information
The program includes an action packed, 60-page book filled with powerful, easy to use, simple techniques for successful elimination of the smoking habit. It can also be effectively used for other addictions.

When combined with power packed coaching support, your success with making life-altering changes is assured.

Please contact me for more information on purchasing the book for self-use, or to learn more about the program.

Lose Weight Workbook. This 26-page workbook contains about 250 questions to stimulate your thinking about why you have an issue with weight gain. (Most clients only check, on the average, about 25 to 40 questions as being relevant to them.)

After completing the project, in-depth coaching inquiry and exploration of hidden agendas can help you to  identify the emotional blocks to losing weight. You will then be able to eliminate them quickly and easily with EFT. This results in an automatically healthier lifestyle.

If you are new to EFT, scroll up to EFT entry above, click on the link to watch the "Amazing Universal Healing Aid" by Gary Craig, EFT Founder.

Testimonial Release Form. This easy to fill out form is for clients who have done work with me and are willing to share their experience with others. I would love it if you would take a few moments to give me your response. :o)